Smallpox vaccination

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

small pox vaccination

Definition
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  • Pre-exposure: vaccination with vaccine virus by making 2 small incisions in the skin with an implantette immersed in lymph. Vaccination is no longer compulsory (Law on protective vaccination repealed in 1982). Primary vaccination (at about 2 years of age) on the right upper arm: normal reaction to vaccination: spot on the 3rd day; 4th day: papule with assembly hall; 5th day: blister; 6th day: pustule with area. After day 12 drying up; bark which falls off after 3 weeks. Development of a varioliform scar. Revacciation (after 10 years) on the left upper arm, faster course of the vaccination reaction.
  • Post-exposure: see above A post-exposure vaccination (if possible within 4 days after exposure) is necessary for all contact persons! Its effectiveness depends on the time of vaccination after exposure and should be carried out as early as possible. A disease cannot always be prevented, but it is possible to attenuate the course of the disease. Often the virus excretion is reduced when vaccinated.

General definition
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  • Although the threat of smallpox in the context of biological weapons use in Europe cannot be ruled out, there is as yet no legal basis for resuming pre-exposure to smallpox vaccination in Germany. However, other countries (USA; Israel) have begun to include military personnel, persons working in crisis areas, decision-makers in state administration, etc. in a smallpox protection programme.
  • At present, more than 60-100 million doses of vaccine are available for post-exposure vaccination in the Federal Government's vaccination reserves at the Federal Office for Sera and Vaccines. This is the same vaccine strain used to eradicate smallpox in the late 1970s.
  • The smallpox vaccine is produced from live lyophilized vaccinia viruses (closely related to the Variola verum virus). The Paul Ehrlich Institute, as the Federal Office responsible for sera and vaccines, has experimentally tested that this vaccine continues to meet the requirements which the WHO had set for the effectiveness of smallpox vaccines at the time of the eradication campaign.

Effects
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Vaccination protection after pre-exposure to smallpox vaccination is about 3 (1-10) years.

Indication
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Limited indication for persons > 65 years. In case of overaged first vaccinated patient usually pre-vaccination with vaccinia antigen is necessary.

Contraindication
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  • Pre-expositional: among others immunosuppression, HIV infection, pregnancy, atopic eczema; however, these must be weighed against the risk of disease in each individual case.
  • Post-exposure: to be weighed against the risk of disease in the individual case.
  • Allergy to ingredients of the smallpox vaccine (polymyxin B, streptomycin, chlortetracycline, neomycin, glycerol, phenol)

Note(s)
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  • Measures after vaccination: Vaccinated persons must be instructed:
    • not to touch the inoculation site until the pustule has fallen off.
    • Cover the vaccination site with gauze and an overlying T-shirt or similar until it dries up, as the vaccination virus can be transmitted to unvaccinated persons through direct contact (touching the vaccination site by third parties).
    • Cover the vaccination site with a skin-friendly foil, especially in working conditions with physical contact to other persons.
    • Change dressings daily and dispose of used dressing material in a waterproof plastic bag.
    • Do not wash, shower or bathe the vaccination site until it dries out.
    • No swimming pool or sauna visit until 3 weeks after vaccination.
    • After touching the vaccination site, wash your hands immediately. It is better to disinfect them with a disinfectant of the effective range B (e.g. Sterillium Virugard).
    • Clothing, towels and bed linen that have come into contact with the vaccination site should be washed for safety reasons (boil wash).
    • Objects (e.g. shower gel, soap) that have come into contact with the vaccination site or the washing process should be disinfected with a disinfectant (e.g. Sterilium Virugard).
  • Storage of the vaccine: The smallpox vaccine can be stored at -20 °C for many years. The solvent (solvent) and the cannulas, lancets or bifurcation needles used for vaccination can be stored at room temperature. Bifurcation needles (two-pronged inoculation needles) are designed in such a way that they absorb exactly 0.0025 ml of inoculation serum by dipping once into the inoculation liquid (capillary forces). In the vaccination centres, refrigerator temperatures of 4 °C are sufficient if the vaccine is used up within four weeks. The dissolved vaccine should be warmed to room temperature before use. Already reconstituted (dissolved) vaccine should also be stored at 4 °C and must be used within one day. Unused vaccine in opened vials must be discarded at the end of the working day.

Caution! To ensure that the vaccine is not impaired in its effectiveness, alcoholic disinfectants used to disinfect the vaccination site (action stage A) must be safely dried on the skin before vaccination is started. Do not use disinfectants containing alcohol with a special virucidal or virustatic spectrum (e.g. Sterilium Virugard).

Literature
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  1. Bartlett JG (2003) Smallpox vaccination and patients with human immunodeficiency virus infection or acquired immunodeficiency syndrome. Clin Infect Dis 36: 468-471
  2. Bartlett J et al (2003) Smallpox vaccination in 2003: key information for clinicians. Clin Infect Dis 36: 883-902
  3. Grist NR (2003) Smallpox and vaccination. Lancet 5: 1228
  4. Lane JM et al (2003) Evaluation of 21st-century risks of smallpox vaccination and policy options. Ann Intern Med 138: 488-493

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Last updated on: 29.10.2020